Remote Behavioral Health Utilization Clinician

CVS Health; Arizona; Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical Coverage

Dental Coverage

Vision Coverage

Retirement Savings Options

Paid Time Off

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role. You will review authorization requests, apply guidelines, and coordinate with facilities to ensure appropriate levels of care for behavioral health services.

The role requires a Master's-level Behavioral Health license or an RN with psychiatric/behavioral health experience, plus utilization management background and inpatient BH experience. Flexible weekday schedule and comprehensive benefits.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state's residents such as LMSW, LCSW, LISW, LPC or equivalent independent clinical license.
• OR active, unrestricted RN license with psychiatric/behavioral health experience.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years of inpatient behavioral health experience in a hospital setting.
• Recent behavioral health-focused work history.
• Ability to work the scheduled hours 12:00 PM – 8:30 PM EST.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Utilize Medicare coverage criteria and requirements when applicable.
• Document determinations, rationale, and recommendations accurately and thoroughly.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care.
• Communicate authorization decisions and next steps to providers and internal stakeholders.
• Identify members who may benefit from additional clinical programs and care management support.
• Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

Behavioral Health License

Utilization Management

Inpatient Behavioral Health

Strong Clinical Decision-Making

Education

Master's degree in Behavioral Health

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role. You will review authorization requests, apply guidelines, and coordinate with facilities to ensure appropriate levels of care for behavioral health services.

The role requires a Master's-level Behavioral Health license or an RN with psychiatric/behavioral health experience, plus utilization management background and inpatient BH experience. Flexible weekday schedule and comprehensive benefits.